Will Your Next Doctor Visit Be With a Robot?

Autonomous robot surgeons now do a better job of stitching than humans – at least in animals. Will your next medical visit be with a robot? Perhaps not – though your doctor may already feel like one. For roboticization of work, particularly through “innovative” IT, is rapidly coming to control your health care.

Bright New Robots

Meet the new STAR – the Smart Tissue Autonomous Robot from Washington’s Children’s National Health System in Washington, DC (please note that the name is no longer Children’s National Hospital; “systems” are apparently a better fit for robots than medical monikers.) Profiled in the Economist of May 7th, STAR is very, very good at performing surgery – in pigs. In a recent paper, STAR carried out 3/5ths of procedures entirely on its lonesome, with better spacing and less leaks than human cutters. Its makers now claim it can do the whole job entirely on its own.

But there’s a rub. STAR takes six times as long to do the work as humans do. That’s a problem with roboticization of medical care, too. Your doc is now spending more and more of her time fitting guidelines, documenting unnecessary details, fighting for reauthorizations. That means less time with you and more time “interfacing” with machines that say no.

Which is just what the masters want.

Fun With Robots

The robots that will drive our cars, fly our planes, fight our battles and cook our food are not the kinds of robots that most affect present lives. Today’s really powerful robots are not machines, but software. These “intelligent” solutions help control most aspects of your health care.

Here are two small examples from daily clinical life. We’ll start with the immutable pairing of drugs and integers. Yes, humans may come in all sizes and forms, as do their diseases – but not, of course, their treatments.

Most of your doctors now receive automatic statements from “pharmacy benefit companies” (ask yourself – who benefits?) that tell them they can order one pill a day of something, but not one and a half or two. These corporations appear to believe that nature abhors fractions – except when it comes to their bottom lines. Point out that some people need half pills, and you are told to stand down. Point out that some folks need two pills to get the reaction they need to function, and you’re told to stuff yourself. Point out that putting together two smaller pills may actually provide a dose that avoids highly unpleasant side effects, and you are given limits of 30 pills in a month. Asked why these arbitrary distinctions are invoked, and you will not get any answer. That the drugs are dirt cheap does not matter. The sensible end result, telling your patient to go to Costco or Wal-Mart where they can buy the stuff for five bucks, also invokes cat calls.

Then a second example – you can do what the Mental Health Parity Act says you should do – try to treat patients with multiple modalities, like psychotherapy and medication, to get the best results. But that’s only the case if you don’t look at the guidelines put out by “private contractors.” They will tell you that psychotherapy and “medical” treatment have totally different goals – and should both be voluminously and separately documented. Not only do you kill more time writing more, but are forced to think of your treatments as unrelated. It’s like telling a chef that salt is “only for taste” and pepper “only for texture.” The health of your patient is just another victim of these policies.

Robodoc

There’s a wonderful grey zone between “guidelines” and “regulations.” Larger corporate entities use that grey zone to exert greater control. But to what end?

We know the game is about profit, and not for the community. Which explains why your doctor may be spending a lot more time treating the chart than treating you – so that she can get paid, and not face “sanctions.”

For who controls the guidelines controls your care. More and more, those guidelines are created “anonymously” by “neutral parties.”

Except there are no neutral parties.

If medical workers of every kind now are treated like robots whose first tasks is to fill out reams of checklists, then what is that care for?

Is it for better physical health? Then we need to look not at proxy but real outcomes – like survival, level of heart attack and stroke. That should presumably benefit the companies that create these guidelines – except that the results “take too long,” and may “benefit” other companies which will take your future business.

So we can dismiss that goal.

Next up are considerations of mental health. You can use metrics for depression and psychosis, family and work function. But those kinds of outcomes are “too complicated” for most corporate entities to consider.

And social and spiritual health – with notably huge effects on overall survival – do not get a hearing at the table.

So today’s “innovative practice patterns” have doctors treat their computer monitors, with health an afterthought. Forget about the doctor as drug – the healing powers of doctor, psychotherapist, nurse, and technician in a common, collective pursuit of health. At best mental health gets a three items checklist, while social health, which in many studies has halved heart disease rates, might rate honorable mention at the next holistic health convention.

In the end it would be better for “health care systems” to focus on people’s lives – their contentment, their wonders, the pleasures of community and the power of connection. Yet we should expect robots will get more attention, for a long time to come.